BECAUSE CREMATION IS IRREVERSIBLE, IDENTIFICATION OF THE DECEDENT IS REQUIRED BY ONE OF THE FOLLOWING METHODS: ***INITIAL AFTER CHOOSING A, B OR C BELOW***

The Authorizing Agent authorizes the Funeral Home & Crematory set forth below to carry out the directions and instructions of the Authorizing Agent contained in the Form.

Funeral Home Name:

Georgia Funeral Care & Cremation Services, Inc.

Funeral Home Address:

4671 S. Main St. Acworth, GA 30101

Crematory Name:

Georgia Funeral Care & Cremation Services, Inc.

Crematory Address:

4671 S. Main St. Acworth, GA 30101

As Authorizing Agent, I have reviewed the priority list in #3 (ABOVE) and I represent that I have the right to authorize the cremation of the decedent's remains and I am initialing one of the following four statements below accordingly: (CHOOSE ONE)

Initial one of the following statements: (Choose One)

The remains are to be cremated in a combustible casket or alternative container that is capable of being completely closed, is resistant to leakage or spillage, is sufficiently rigid to be handled easily, and provides protection for the health and safety of Crematory and Funeral Home personnel. The Crematory is authorized to inspect the casket or alternative container, including opening it if necessary. In the event that the casket or container does not meet the above requirements, the Crematory will notify the authorizing Agent. Many caskets are comprised primarily of combustible material also contain some exterior parts (decorative handles or rails) that are not combustible and that may cause damage to the cremation equipment. As Authorizing Agent, I authorize Crematory, in its discretion, to remove and discard the non-combustive materials. I understand that some crematories will not accept metal or fiberglass caskets. I further understand that the casket or alternative container will be consumed as part of the cremation process.

Witnessing a cremation can be an emotional experience. Witnesses are assuming the risks involved and fully release the Funeral Home and Crematory from any liability. To the extent permitted by Crematory, the persons listed on the reverse side are authorized to be present at the cremation room prior to and during the cremation of the Decedent's remains and during the removal of the cremated remains from the cremation chamber. If you desire witnesses, you must initial below and list the witness names. (CHOOSE ONE)

I have read and I understand the following:

1. The cremation of the Decedent's remains may take place before or after ceremonies to memorialize the Decedent. Cremation is performed to prepare the remains of the Decedent for final disposition. It is carried out by placing the Decedent's remains in the casket or alternative container, which is then placed into a cremation chamber or retort where they are subjected to intense heat and flame. All cremations are performed individually. During the cremation process, it may be necessary to open the cremation chamber and reposition the remains of the Decedent in order to facilitate a complete and thorough cremation. Through the use of a suitable fuel, the incineration of the container and its contents is accomplished and all substances are consumed or driven off, except bone fragments (calcium compounds) and metal (including dental gold and silver and other non-human materials) as the temperature is not sufficient to consume them. 
2. Due to the nature of the cremation process, any personal possessions or valuable materials, such as dental gold or jewelry (as well as anybody prostheses or dental bridgework) that are left with the remains and not removed from the casket or container prior to the cremation may be destroyed or if not destroyed, will be disposed of by the crematory. The Authorizing Agent understands that arrangements must be made with the Funeral Home to remove any such possessions or valuable prior to the time that the remains of the Decedent are transported to the Crematory.
3. Following a cooling period, the cremated remains, which will normally weigh several pounds in the case of an average-size adult, are then swept or raked from the cremation chamber. Although the Crematory will take reasonable efforts to remove all of the cremated remains from the cremation chamber, it is impossible to remove all of them, as some dust and other residue from the process will be left behind. In addition, while every effort will be made to avoid commingling, inadvertent and incidental commingling of minute particles of cremated remains from the residues of a previous cremation is a possibility, and the Authorizing Agent understands and accepts this fact.
4. After the cremated remains are removed from the cremation chamber, all non-combustible material (in so far as possible) such as denta bridgework and hinges, latches, and nails from the container will be separated and removed from the human bone fragments by visible or magnetic selection. The Crematory is authorized to dispose of these materials with similar materials from other cremations in a non-recoverable manner, so that only human bone fragments will remain.
5. When the cremated remains are removed from the cremation chamber, the skeletal remains often will contain recognizable bone fragments. Unless otherwise specified, after the bone fragments have been separated from the other material, they will be mechanically pulverized. The process of crushing or grinding may cause incidental commingling of the remains with the residue from the processing of previously cremated remains. These granulated particles of unidentifiable dimensions, which are virtually unrecognizable as human remains will then be paced into a designated container.

As Authorizing Agent, I have read and understand the description of the cremation process contained in #8 in this form and authorize the cremation, processing and pulverization of the remains of the Decedent.

After the cremated remains have been processed, they will be placed in the urn listed on reverse side or, if an urn is not provided to the Crematory, a temporary container will be provided by the Crematory. The Authorizing Agent acknowledges that it is impossible to recover all the dust and residue
from the cremation and processing.

In the case of an adult, it is recommended that the urn or temporary container be a minimum size of 200 cubic inches. In the event the urn or temporary container is insufficient to accommodate all the cremated remains, the excess will be placed by the Crematory in a secondary container. This secondary container will be kept with the urn or temporary container and handled according to the final disposition instruction set forth in section 11, provided, however, that the secondary container may not be designed for shipping. All urns or containers provided to the Funeral Home or Crematory must be appropriate for shipping. The Authorizing Agent directs the Crematory to use the specified urn or container listed in #10.

PLEASE INITIAL THE OPTION SELECTED AFTER READING THE FOLLOWING: (CHOOSE ONLY ONE)

1. Following the Cremation, the Authorizing Agent directs the Crematory and/or Funeral Home to undertake the actions set forth  to arrange the final disposition of the cremated remains of the Decedent. If the cremated remains are shipped at any time, the Authorizing Agent directs that the Crematory or Funeral Home utilize the U.S. Postal Service's Priority Mail Express Service with a return receipt or a shipping service that uses an internal system of tracing the location of the cremated remains during shipment and requires a signed receipt of the person taking delivery of the cremated remains. If shipment by the U.S. Post Office or other deliver company is directed, the Authorizing Agent acknowledges and agrees that there is a risk that the cremated remains could be lost.
2. The Authorizing Agent understands that if no arrangement for the final disposition, release or shipment of the cremated remains is made in this Authorization, the Crematory or Funeral Home shall hold the cremated remains for sixty (60) days after cremation. If during that sixty (60) day period, the cremated remains are not retrieved by the person designated in this document to receive them or by the Authorizing Agent, or if arrangements for their final disposition are not made, notice will be sent to the Authorizing Agent informing the Authorizing Agent that the cremated remains will be interned or stored if not retrieved in the next thirty (30) days. 
3. Thirty (30) days after the written notice is sent to the Authorizing Agent, if no arrangements for the final disposition of the cremated remains have been made or the Authorizing Agent has not taken delivery of or caused the delivery of the cremated remains, then the Funeral Home may dispose of the cremated remains in a grave or crypt, by storing the cremated remains in the Funeral Home. The authorizing Agent shall be liable for the cost of such final disposition in a grave or crypt and shall reimburse the Funeral Home immediately upon receipt of an invoice.

All personal property and effects delivered with the remains of the Decedent to the Funeral Home/Crematory, including jewelry, clothes, hair pieces, dental bridgework, eyeglasses, shoes, etc., will be destroyed in the cremation process or otherwise discarded by the crematory, in its sole discretion, unless specific instructions are given by the Authorizing Agent below:

Prior to the cremation of the Decedent's remains, the Authorizing Agent or decedent's family have arranged for a viewing/ceremony set forth below:

Please initial one of the following:

The Authorizing Agent acknowledges that the Funeral Home and Crematory are relying upon the representations being made by the Authorizing Agent in this Authorization. The Authorizing Agent certifies that all of the information and statements contained in the Authorization are accurate and no omissions of any material fact have been made. The Authorizing Agent agrees to indemnify and hold harmless the Funeral Home and Crematory, their officers, directors, employees and agents from any and all claims, demands, actions, causes of action or suits of any kind or nature whatsoever, including, but not limited to, any legal fees arising out of or resulting from the Funeral Home's and Crematory's reliance on or performance consistent with the directions, statements, representations, and agreements contained in the Authorization.